Healthcare Provider Details

I. General information

NPI: 1689086647
Provider Name (Legal Business Name): REGLA MARIA CASOLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14285 SW 42ND ST STE 205-207
MIAMI FL
33175-6410
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-2165
  • Fax: 786-621-7812
Mailing address:
  • Phone: 786-322-7333
  • Fax: 786-347-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9214124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: